Vestibular Migraine: Dizziness and Vertigo With Migraine
Vestibular migraine is a type of migraine that mainly affects your balance. It can make you feel like you or the room are spinning, swaying or rocking, sometimes with no headache at all.
What is vestibular migraine?
“Vestibular” refers to the inner ear and the body’s balance system. In vestibular migraine, the main symptom is vertigo or dizziness rather than head pain.
- Vertigo is the sense that you or your surroundings are moving (spinning, tilting or swaying) while everything is actually still.
- Dizziness is a broader word for feeling lightheaded or off balance without a sense of motion.
A typical patient described by the American Migraine Foundation (AMF) is a woman in her late 30s or 40s with a past history of migraine and motion sickness. Many people recall being sensitive to motion as children, and many have family members with migraine or similar dizzy spells. Headaches may ease with age while the balance symptoms become more common.
Common symptoms
- Vertigo, which can happen before, during or after the headache, or on its own
- Sensitivity to light and sound
- Ear pain, pressure or ringing
- Brain fog, tiredness or trouble finding words
- Blurry vision, tingling or scalp tenderness
- Sweating, dry mouth, yawning or diarrhea
Some people notice that objects look larger or smaller than they really are, sometimes called “Alice in Wonderland” syndrome. Vestibular migraine can also happen alongside regular migraine attacks, with or without aura. These symptoms can make driving, work and travel hard.
What can trigger it
Vertigo can start on its own or be set off by moving your head, holding your head in certain positions, or looking at busy patterns or moving objects. Common migraine triggers can also play a part:
- Stress
- Too little sleep or changes in sleep
- Hormone changes, such as the menstrual cycle
- Weather changes
- Bright or flashing lights
- Skipped meals, and foods or drinks such as caffeine, chocolate or alcohol
Not every attack has a clear trigger. A symptom and headache journal can help you find patterns.
How it is diagnosed
There is no single test. The diagnosis rests on a clear link in time between your dizzy spells and migraine features. According to the National Headache Foundation (NHF), the criteria include:
- At least five episodes of vertigo or dizziness
- In half or more of those episodes, a migraine symptom such as headache, light or sound sensitivity, or a visual aura
Because other problems can cause dizziness, doctors may use balance testing, hearing tests and a careful exam to rule them out. Two conditions the NHF names:
- Meniere’s disease: linked with hearing loss in one ear, especially of low sounds. It can exist alongside vestibular migraine.
- Benign paroxysmal positional vertigo (BPPV): short spells of vertigo set off by head movement. It is treated with specific head-movement maneuvers rather than migraine medicines.
Treatment options
There is no cure, but many people learn to manage their symptoms with the help of an experienced headache specialist. Options named by the AMF and NHF include:
- Preventive medicines: some anti-seizure medicines, beta-blockers, antidepressants and CGRP blockers
- Rescue medicines: triptans, anti-inflammatory pain relievers and newer CGRP blockers
- Nerve stimulation devices: such as vagus nerve or external trigeminal nerve stimulators
- Supplements: vitamin B2, magnesium and coenzyme Q10
- Lifestyle steps: finding and tracking your triggers
See a provider if vertigo or dizziness is frequent or severe, comes with migraine features, gets worse over time, or does not respond to usual migraine treatment. Hearing loss, ongoing ear ringing, or changes in vision or balance are also reasons to get checked.
What patients say
5.0 from 21 Google reviews
★★★★★
Dr. Park lives up to her name -- she parked my vestibular migraines! I had been suffering for a year with near constant migraines (having already tried one neurologist) and in one session I was already feeling better. She is caring and really listens to her patients, taking care to figure out the best course for you. I highly recommend her!
Reviews are shared from Google in the patients’ own words. Individual experiences vary.
How Dr. Park can help
Dr. Hannah Park is a dual board-certified, fellowship-trained headache medicine neurologist with over 10 years of specialized experience. Vestibular migraine and dizziness with headache are among the conditions she treats. Your first visit is a 90-minute consultation with Dr. Park: a full history review, a neurological exam, a diagnosis and a personalized treatment plan.
The practice focuses on targeted injection treatments, such as an occipital nerve block or an SPG block (no needles), rather than a cycle of prescription medicines. See services and fees. The practice is direct pay, with no referral needed, and appointments are usually available within days.
When to get emergency care
Call 911 or go to the nearest emergency room if you have new, sudden dizziness that is unusual for you, trouble walking, weakness on one side of the face or body, numbness, trouble speaking or vision changes, especially if these feel different from your usual attacks or last much longer.
Related
Sources
This page summarizes patient information from these organizations, in our own words. It is general education, not medical advice.
- What to Know About Vestibular Migraine, American Migraine Foundation
- Vestibular Migraine, National Headache Foundation
- Migraine in the Emergency Department: When to Go to the ED for Migraine, American Migraine Foundation
Last updated October 27, 2026.
Dizzy spells and migraine? Get them evaluated.
Every patient starts with a 90-minute new patient visit with Dr. Park.